Provider Demographics
NPI:1821171349
Name:SPICER, THOMAS E (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:SPICER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 HILLTOP DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5857
Mailing Address - Country:US
Mailing Address - Phone:307-362-8211
Mailing Address - Fax:307-382-3451
Practice Address - Street 1:1208 HILLTOP DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5857
Practice Address - Country:US
Practice Address - Phone:307-362-8211
Practice Address - Fax:307-382-3451
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY2513A208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY103963600Medicaid
WYW308597OtherMEDICARE PROVIDER NUMBER
WYW308596OtherKRIS SHERWIN PA-C MEDICAR
WY240000693OtherRAILROAD MEDICARE GROUP MEMBER PTAN
WY830274490OtherTAX ID #
WYDN9829OtherRAILROAD MEDICARE GROUP PTAN
WYW308595OtherMEDICARE GROUP
WY240000693OtherRAILROAD MEDICARE
WY1033342563OtherAMBULATORY SURGERY CENTER
WY103963600Medicaid